Pediatric neck abscesses: changing organisms and empiric therapies.
OBJECTIVE
To examine the causative organisms in pediatric neck infections, delineate risk factors in methicillin-resistant Staphylococcus aureus (MRSA) pediatric neck infections, and define patient populations that should be empirically treated with MRSA sensitive antibiotics.


METHODS
Retrospective chart review.


METHODS
Two hundred twenty-eight consecutive patients were reviewed, ages 0 to 17, presenting at a tertiary care center between 1999 and 2007 with computed tomography proven neck abscesses. Characteristics of patients with differing causative organisms were compared.


RESULTS
Forty-eight percent of all pediatric patients' with head and neck abscesses had S. aureus as the causative organism, 29% of which were community-acquired MRSA -- recent years showed that up to 66% of pediatric neck abscesses were MRSA culture positive. When comparing MRSA infections vs. other causative organisms multiple clinical characteristics were found which did not help to differentiate those patients at a higher risk for MRSA. Characteristics which did trend to predict an MRSA infection were few. For example, the average age of patients with MRSA was 32.5 months compared with only 16 months for the methicillin-sensitive S. aureus patients. MRSA sensitivities and resistances were also examined.


CONCLUSIONS
This study presents a large cohort of pediatric neck abscess patients, in which the emergence and characteristics of MRSA are shown. As community-acquired MRSA infections become more prevalent, empiric antibiotic therapy must be considered. The results of this study show that the incidence of MRSA has greatly increased and clinical risk factors are not helpful in choosing those patients which may be at higher risk for an MRSA infection.
Inman
Jared C
JC
Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
Rowe
Mark
M
Ghostine
Michelle
M
Fleck
Terry
T
D000038:Abscess / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D004322:Drainage; D019348:Empiricism; D004917:Erythromycin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008826:Microbial Sensitivity Tests; D010038:Otorhinolaryngologic Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002981:Clindamycin; D004917:Erythromycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination